,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #dfgi  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #ah1         
#bjag,mr4 ,re$ 7= himself & ,mr4        
,rei*]t7 introduc$ ! foll[+ bill2 :i* 0 
ref]r$ to ! ,committee on ,ways &       
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide = improvem5ts to cov]age &      
paym5t "u ! ,m$ic>e program = new drugs1
 devices1 & te*nology4  #a4 ,%ort title 
,?is ,act may be cit$ z ! ,ensur+ ,equal
 ,access to ,treatm5ts ,act ( #bjag4    
#b4 ,cov]age & paym5t = new drugs1      
devices1 & te*nology "u ! ,m$ic>e       
program  7a7 ,improvem5ts to ,,ntap     
paym5t adju/m5t "u ! inpati5t           
prospective paym5t sy/em  7#a7 ,paym5t =
 co/s ( new te*nologies ,) respect to   
hospital dis*>ges occurr+ on or aft]    

,octob] #a1 #bjah1 = :i* paym5t is made 
"u section #ahhf7;d7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acieww7d771 9 calculat+ ! am\nt ( !    
additional paym5t = a new m$ical s]vice 
or te*nology "u p>agraph 7#e77,k7 ( su* 
section ) respect to su* a dis*>ge1 !   
,secret>y ( ,heal? & ,human ,s]vices    
%all apply section #dab4hh ( title #db1 
,code ( ,f$]al ,regulations--  7,a7 z if
 ! ref]5ce to #ej p]c5t ea* place x     
appe>s 9 su* section 7 a ref]5ce to #ge 
p]c5t2 &  7,b7 z if p>agraph 7b7 ( su*  
section did n include ,unless a dis*>ge 
case qualifies = outli] paym5t "u       
#dab4hd44  7#b7 ,revision to ! co/      
?re%old ,section #ahhf7;d77#e77,k7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7d77#e77,k77 is am5d$-- 7,a7 9   
clause 7ii7--  7i7 9 subclause 7,i71 by 
/rik+ #ge p]c5t ea* place x appe>s &    
ins]t+ #ej p]c5t2 &  7ii7 9 subclause   
7,,ii71 by /rik+ n less ?an two ye>s & n
 m ?an ?ree ye>s & ins]t+ five ye>s2 &  
7,b7 9 clause 7iii71 by /rik+           

,int]national ,classification (         
,diseases1 #i? ,revision1 ,cl9ical      
,modification 7#8#8,,icd-#i-;,,cm''7 &  
ins]t+ ,int]national ,classification (  
,diseases1 #aj? ,revision1 ,cl9ical     
,modification 7#8#8,,icd-#aj-;,,cm''74  
7#c7 ,revision to ! comm5cem5t ( ! p]iod
 = collection ( co/ data = new          
te*nologies ,section                    
#ahhf7;d77#e77,k77ii77,,ii7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#e77,k77ii77,,ii77 is am5d$  
by ins]t+ ! lat] ( ! date t is ! date ( 
! cle>ance or approval by ! ,commission]
 ( ,food & ,drugs ( ! s]vice or         
te*nology or aft] beg9n+ on4  7#d7      
,p]mitt+ appeals ( ntap det]m9ations    
7,a7 ,9 g5]al ,section #ahhf7;d77#e77,k7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acieww7d77#e77,k77 is am5d$  
by add+ at ! end ! foll[+ new clause3   
7x7  7,i7 ,an individual or entity t    
submits an application = additional     
paym5t "u ?is subp>agraph = a new       
te*nology %all be entitl$ to            

adm9i/rative review ( an adv]se         
det]m9ation by ! ,secret>y ) respect to 
su* application4  7,,ii7 ,! ,secret>y   
%all e/abli% a process = adm9i/rative   
review = purposes ( subclause 7,i74 ,"u 
su* process1 adm9i/rative review %all be
 conduct$ by ! ,dep>tm5tal ,appeals     
,bo>d ( ! ,dep>tm5t ( ,heal? & ,human   
,s]vices4 ,"u su* process1 ! ,dep>tm5tal
 ,appeals ,bo>d %all complete           
adm9i/rative review )9 #ij days ( ! date
 ( receipt ( ! reque/ = su* review4  4  
7,b7 ,con=m+ am5dm5t ,section           
#ahhf7;d77#g77;,b7 ( su* ,act 7#db      
,u4,s4,c4 #acieww7d77#g77;,b77 is am5d$ 
by ins]t+ b n includ+ a d5ial by !      
,secret>y ( an application = additional 
paym5t "u p>agraph 7#e77,k7 aft]        
p>agraph 7#d77;,d74  7#e7 ,requir+ new  
,,drg codes = new te*nologies com+ (f ( 
new te*nology add-on ,section           
#ahhf7;d77#e77,k77ii77,,iv7 ( su* ,act  
7#db ,u4,s4,c4                          
#acieww7d77#e77,k77ii77,,iv77 is am5d$  
by /rik+ or exi/+4  7#f7 ,limit on      

aggregate annual adju/m5t ,section      
#ahhf7;d77#e7 ( su* ,act 7#db ,u4,s4,c4 
#acieww7d77#e77 is am5d$ by add+ at !   
end ! foll[+ new subp>agraph3  7,m7     
,limit on aggregate annual adju/m5t  7i7
 ,9 g5]al ,! total ( ! additional       
paym5ts made "u subp>agraphs 7,k7 & 7,l7
 = cov]$ s]vices furni%$ = dis*>ges 9 a 
fiscal ye> 7z e/imat$ by ! ,secret>y    
be=e ! beg9n+ ( ! fiscal ye>7 may n     
exce$ ! applicable p]c5tage 7specifi$ 9 
clause 7ii77 ( ! total program paym5ts  
e/imat$ to be made "u ?is subsection =  
all cov]$ s]vices furni%$ = dis*>ges 9 t
 fiscal ye>4 ,if ?is clause is fir/     
appli$ to less ?an a full fiscal ye>1 ! 
previ\s s5t5ce %all apply only to !     
portion ( su* fiscal ye>4  7ii7         
,applicable p]c5tage ,= purposes (      
clause 7i71 ! t]m #8applicable p]c5tage'
 = fiscal ye> #bjai & ea* subsequ5t     
fiscal ye>1 is a p]c5tage specifi$ by ! 
,secret>y up to 7b n to exce$7 #b4j     
p]c5t4  7iii7 ,uni=m prospective        
r$uction if aggregate limit project$ to 

be exce$$ ,if ! ,secret>y e/imates be=e 
! beg9n+ ( a fiscal ye> t ! am\nt ( !   
additional paym5ts "u subp>agraphs 7,k7 
& 7,l7 = ! fiscal ye> 7or portion !re(7 
z det]m9$ "u clause 7i7 )\t reg>d to ?is
 clause w exce$ ! limit e/abli%$ "u su* 
clause 7i71 ! ,secret>y %all r$uce pro  
rata ! am\nt ( ea* ( ! additional       
paym5ts "u ?is p>agraph = t fiscal ye>  
7or portion !re(7 9 ord] to ensure t !  
aggregate additional paym5ts "u         
subp>agraphs 7,k7 & 7,l7 7z s e/imat$7 d
 n exce$ su* limit4  4  7#g7 ,effective 
date ,! am5dm5ts made by p>agraphs 7#b71
 7#c71 7#d71 7#e71 & 7#f7 %all take     
effect on ! date ( ! enactm5t ( ?is ,act
 & %all apply ) respect to hospital     
dis*>ges occurr+ on or aft] ,octob] #a1 
#bjah1 = inpati5t hospital s]vices = :i*
 paym5t is made "u section #ahhf7;d7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acieww74  7b7 ,improvem5ts to paym5t   
adju/m5t "u ! ,m$ic>e outpati5t         
prospective paym5t sy/em = c]ta9 drugs &
 devices eligible or previ\sly eligible 

= pass-,?r\gh  7#a7 ,requir+ sep>ate    
ambulatory paym5t classification = c]ta9
 drugs & devices previ\sly eligible =   
pass-?r\gh paym5ts ,section #ahcc7t7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciel7t77 is am5d$-- 7,a7 9 p>agraph   
7#b7--  7i7 9 subp>agraph 7,g71 by /rik+
 & at ! end2  7ii7 9 subp>agraph 7,h71  
by /rik+ ! p]iod at ! end & ins]t+ 2 &2 
&  7iii7 by add+ at ! end ! foll[+ new  
subp>agraph3  7,i7 ! ,secret>y %all     
create additional gr\ps ( cov]$ ,,opd   
s]vices t classify sep>ately proc$ures &
 s]vices t employ m$ical devices & drugs
 describ$ 9 a subp>agraph ( p>agraph    
7#bb71 9 accordance ) su* p>agraph4  2 &
  7,b7 by add+ at ! end ! foll[+ new    
p>agraph3  7#bb7 ,sep>ate additional    
paym5t gr\ps = c]ta9 drugs & devices    
previ\sly eligible = pass-?r\gh paym5ts 
,= purposes ( p>agraph 7#b77;,i71 !     
foll[+ %all apply3  7,a7 ,9 g5]al ,=    
paym5ts "u ?is subsection = s]vices     
furni%$ on or aft] ,janu>y #a1 #bjbj1 ! 
,secret>y %all1 9 accordance )          

subp>agraph 7,b71 create additional     
gr\ps ( cov]$ ,,opd s]vices to classify 
sep>ately f o!r cov]$ ,,opd s]vices !   
foll[+3  7i7 ,exi/+ pass-?r\gh drugs &  
devices ,m$ical devices & drugs t met ! 
requirem5ts ( p>agraph 7#f77;,a77iv7 & 7
 receiv+ paym5t "u p>agraph 7#f7 by     
reason ( satisfy+ su* requirem5ts beg9n+
 on or aft] ! date ( enactm5t ( ?is     
p>agraph4  7ii7 ,retir$ pass-?r\gh drugs
 & devices ,m$ical devices & drugs t _h 
met ! requirem5ts ( p>agraph            
7#f77;,a77iv7 & 7 receiv+ paym5t "u     
p>agraph 7#f7 by reason ( satisfy+ su*  
requirem5ts be=e ! date ( enactm5t ( ?is
 p>agraph b aft] ,janu>y #a1 #bjaj4     
7,b7 ,consid]ations ,9 c>ry+ out        
subp>agraph 7,a71 ! ,secret>y %all-- 7i7
 bundle proc$ures & s]vices t employ a  
device to :i* su* subp>agraph applies ) 
all relevant diagno/ic te/s & surgical  
proc$ures1 z applicable2  7ii7 bundle   
proc$ures & s]vices t employ a drug1 )  
respect to :i* paym5t is n made on or   
aft] ! date specifi$ 9 subp>agraph 7,a7 

9 accordance ) ! me?odology "u section  
#ahdg;,a & to :i* su* subp>agraph       
applies1 ) all relevant diagno/ic te/s &
 surgical proc$ures1 z applicable2 &    
7iii7 include su* relevant diagno/ic    
te/s & surgical proc$ures 9 m ?an "o    
gr\p creat$ "u su* subp>agraph1 z       
necess>y4  4  7#b7 ,revision to         
pass-?r\gh p]iod "u ,,opps ,section     
#ahcc7t77#f7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciel7t77#f77 is am5d$--
 7,a7 9 subp>agraph 7,b77iii71 by /rik+ 
at lea/ #b ye>s1 b n m ?an #c ye>s &    
ins]t+ #e ye>s2 &  7,b7 9 subp>agraph   
7,c77i71 by /rik+ at lea/ #b ye>s1 b n m
 ?an #c ye>s & ins]t+ #e ye>s4  7#c7    
,appeals process ,section #ahcc7t77#f7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciel7t77#f77 is am5d$ by add+ at !   
end ! foll[+ new subp>agraph3  7,f7     
,appeals process  7i7 ,9 g5]al ,an      
individual or entity t submits an       
application = additional paym5t "u ?is  
p>agraph = a new te*nology %all be      
entitl$ to adm9i/rative review ( an     

adv]se det]m9ation by ! ,secret>y )     
respect to su* application4  7ii7       
,process ,! ,secret>y %all e/abli% a    
process = adm9i/rative review = purposes
 ( clause 7i74 ,"u su* process1         
adm9i/rative review %all be conduct$ by 
! ,dep>tm5tal ,appeals ,bo>d ( !        
,dep>tm5t ( ,heal? & ,human ,s]vices4   
,"u su* process1 ! ,dep>tm5t (ficial    
involv$ %all complete adm9i/rative      
review )9 #ij days ( receipt ( a reque/ 
= su* review4  4  7#d7 ,effective date  
,! am5dm5ts made by p>agraphs 7#b7 &    
7#c7 %all take effect on ! date (       
enactm5t ( ?is ,act & %all apply )      
respect to items & s]vices furni%$ on or
 aft] ,janu>y #a1 #bjbj4